Professor Richard Stark Botox for Chronic Migraine Interview

Professor Richard Stark Botox for Chronic Migraine Interview

BOTOX (botulinum toxin, type A) is now available Australia-wide as an effective treatment option for adults living with Chronic Migraine, a debilitating condition that affects over 345,800 Australians.

Chronic Migraine is defined as patients experiencing headaches for 15 days or more per month with a migraine on at least eight of these days. Migraines - a disabling type of headache - can last four hours or longer each day.

BOTOX is the latest therapy available in Australia for the prevention of headache in adults suffering from this complex neurological disorder.

According to Associate Professor Richard Stark, Neurologist, Chronic Migraine stops sufferers in their tracks, often preventing them from even basic activities.

"Chronic Migraine is a distinct and devastating condition. Due to the severity and frequency of the headaches, people with Chronic Migraine find it hard to function in their daily lives. Their migraines can last for days. Tasks such as working or caring for children can prove challenging and sometimes are not even possible," he said.

As reported in the World Health Organisation (WHO) Bulletin, a day lived with severe migraine, either 'episodic' (occasional) or 'chronic' (frequent) is as disabling or more so as a day lived with dementia, active psychosis, paraplegia, blindness or rheumatoid arthritis. As the most severe type of migraine, Chronic Migraine is associated with substantial physical, social, psychological and economic burden for its sufferers, yet it often goes undiagnosed and untreated.

"Chronic Migraine is not widely recognised and often goes undiagnosed. Furthermore, the condition is made more complex as people with Chronic Migraine tend to overuse strong painkillers to deal with the frequent headaches. This acute medication use can cause more headaches and perpetuate the problem, so having access to a specific treatment that is effective in preventing Chronic Migraine symptoms is a significant step forward," commented Professor Stark.

BOTOX is a new addition to the treatment options available for Australians diagnosed with Chronic Migraine, following the world's largest clinical trial to date on this condition.

Specifically for Chronic Migraine sufferers, the results show that treatment with BOTOX can significantly reduce the number of headache days per month, in addition to reducing acute medication use and increasing the number of migraine-free days (compared to pre-treatment).

Also reducing the severity of headaches, BOTOX treatment can improve a Chronic Migraine patient's quality of life (compared to pre-treatment).

To determine the impact of migraine on sufferers, Headache Australia and Allergan recently surveyed 435 people who are affected by the condition. The results highlighted that migraine has a notable negative impact on the lives of people who suffer from them, be it occasionally or regularly.

Almost half (47 per cent) of all respondents stated that their migraines had a notable negative impact on their quality of life (rating 8 or above on a Richter Scale with 10 being 'significantly negative'). Approximately three out of five (61 per cent) describe the pain of a migraine as 'unbearable and agonising'.

Over a third (36 per cent) of regular migraine sufferers (9 or more migraines per month) reported that they were prevented from going to work on more than two occasions per month due to the condition, and 42 per cent said they were prevented from working full time.

Furthermore, more than three out of four (87 per cent) of regular migraine sufferers reported that the condition had a significant impact on their personal relationships.

"Migraines, whether episodic or chronic, can disable a person and drastically reduce their quality of life and those around them. The recent survey results further highlight this. It is important that people suffering migraines see their GP and ensure that they are diagnosed correctly, as there are new treatments that might be more effective and appropriate for their condition," said Gerald Edmunds, Secretary General of Headache Australia.

Since the inclusion of BOTOX for Chronic Migraine on the Australian Register of Therapeutic Goods (ARTG), Allergan has been focused on training key neurologists and certain pain specialists across Australia to be able to effectively treat those patients that are eligible. For regular headache and migraine sufferers to understand how the condition is impacting them, Professor Stark recommends keeping a diary: "A diary allows people to record how frequently they suffer from headaches. If they look to be suffering from them on more than 15 days per month, they should think about speaking with their GP about being referred to a neurologist in order to discuss their condition and treatment options."

Administered by a trained neurologist or pain specialist, BOTOX can be used for the prophylaxis (prevention) of headaches in Chronic Migraine patients aged 18 years or over and can provide relief for up to three months.

Interview with Professor Richard Stark

Question: How is Botox used to treat Chronic Migraines?

Professor Richard Stark: The way we use it is to inject in a number of points around the scalp. There are various protocols for doing it but the one that is shown to be the best involves injecting Botox in 31 different spots around the scalp; above the eyes, in the temple and forehead, the back of the head and some of the muscles in the back of the neck.


Question: Can you describe the symptoms of a Chronic Migraines?

Professor Richard Stark: Migraines are severe headaches that occur very often, a migraine is associated with other features such as nausea, vomiting, light and sound sensitivity and a throbbing pain which is severe and disabling. Most patients with migraines get those headaches occasionally; but there is a subgroup who have migraines very frequently and we've recognised that they behave differently and it is worthwhile to give them a different name. The name Chronic Migraine refers to those who have headaches more than 15 days a month which last for more than four hours on each of those days and with many of those headaches having migraine features such as nausea and vomiting.
Some people have migraines 30 days a month, every day. To make the definition of Chronic Migraine you need to have one 15 days or more, in a month.


Question: Does Botox as a treatment for Chronic Migraines have any side effects?

Professor Richard Stark: Botox has very few side effects. Obviously you need to inject it so there can be bruising at the points you inject it. Botox works by getting into nerve fibers and stopping them from releasing some of their chemicals and an affect from that is that it stops the muscles in that area moving, there are not a lot of important muscles around the head and neck area that cause a problem but occasionally when the Botox goes into the muscles around the eyebrows you can sometimes have the eyelids drooping, occasionally. The areas that are injected have actually been designed to minimise that risk and in practice it doesn't happen very often, although it is possible to happen.

It is quite safe as the doses of Botox in treating headaches is much less than we use for some other neurological conditions such as spasms of muscles around the head and necks and in children with Cerebral Palsy to try and help loosen up the muscles, for them; in those situations it is used in much higher doses than we use for headaches.

There doesn't seem to be any major problems with general side effects and as I said the local side effects are a little bit of bruising where you do the injections and very rarely the drooping of the eyebrow.


Question: How common are Chronic Migraines amongst Australians?

Professor Richard Stark: People who have done surveys have found it is 2% of the adult population; it's not as rare as you may think.

Question: What is the cost involved in Botox as a treatment for Chronic Migraines?

Professor Richard Stark: In Australia this treatment is not funded by the health system and in Australia Botox comes in vials of 100 units so if you use the full suggested dose from the overseas trials, that is 155 units that involves opening two vials; the cost including the vials and the cost of injecting the Botox is about $575-$600 per vial. If you are to use the full dose it's about $1,200 per set of injections.


Question: How regularly does Botox have to be administrated to treat Chronic Migraines?

Professor Richard Stark: Every three months. People who have Chronic Migraines are often quite disabled by them; many can't work or reliably be involved in social and family events, Botox can improve the symptoms so patients can work and function which is why it is quite worthwhile. The patients that I have treat, regard Botox as a worthwhile investment, obviously it works well for some people and not as well for others.


Interview by Brooke Hunter